Journal
AMERICAN JOURNAL OF CARDIOLOGY
Volume 99, Issue 12A, Pages 34I-43IPublisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjcard.2007.03.004
Keywords
-
Categories
Funding
- NHLBI NIH HHS [Y1-HC-1010, N01-HC-95181, N01-HC-95184, N01-HC-95180, N01-HC-95179, N01-HC-95178, Y1-HC-9035, N01-HC-95182, N01-HC-95183] Funding Source: Medline
Ask authors/readers for more resources
There is an independent progressive epidemiologic relation between glycemia and cardiovascular disease (CVD) events; however, whether lowering glucose levels with currently available therapies can reduce CVD events remains unknown. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial is designed to answer this question in high-risk patients with type 2 diabetes mellitus. In ACCORD, 10,251 patients with type 2 diabetes and other CVD risk factors or CVD were randomly allocated to intensive glycemic control, targeting a glycosylated hemoglobin (HbA(1c)) level < 6%, or standard glycemic control, targeting an HbA(1c) level of 7.0%-7.9%. All participants are provided with diabetes education, glucose-monitoring equipment, and antidiabetic medications. All participants in the intensive glycemic control group are started on >= 2 classes of agents. Doses are intensified or a new medication class is added every month if HbA(1c) levels are >= 6% or if > 50% of premeal or postmeal capillary glucose readings are > 5.6 mmol/L (100 mg/dL) or > 7.8 mmol/L (140.mg/dL), respectively. All drug combinations are permitted, and drugs are reduced only because of side effects or contraindications. Annual training, menus of approaches for intensification, regular electronic messaging, audits of achieved glycemia, and central feedback to sites support glycemic intensification strategies in intensive participants. In participants in the standard glycemic control group, therapy is intensified whenever HbA(1c) is >= 8%, and antihyperglycemic drugs that promote hypoglycemia (ie, insulin or insulin secretagogues) are reduced if HbA(1c) persistently decreases to < 7% in the setting of hypoglycemia. ACCORD addresses the hypothesis that aggressive glucose lowering prevents CVD events in patients with type 2 diabetes. It is focused on the levels of glycemia achieved using a variety of strategies, not on the specific therapies used. It will also provide information on how to safely approach near-normal levels of glucose control in clinical practice and evidence to support future clinical guidelines for diabetes management in older adults. (c) 2007 Elsevier Inc. All rights reserved.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available